In England for nearly twenty years the supervision and instruction of expectant mothers has been an integral part of the work of midwives who are trained, registered and controlled by government authority. Of late the work among mothers and babies has been so extended that during the war, always a destructive period for babies, the infant death rate was reduced to the lowest figure in the country’s history. This was accomplished partly through a maternity benefit which helped the mother to pay for obstetrical care, and partly through indirect government aid, in the form of: compulsory notification of births; a great increase in the number of “health visitors” and welfare centres, and government grants to local authorities which defrayed half the expense of giving prenatal, natal and postnatal care and of instructing mothers in the care of themselves and their babies. Especial effort has been made to help the mothers in rural sections; more small hospitals being maintained, more physicians being provided and assistance given in caring for older children, during the mother’s absence, if she was obliged to go to a hospital at the time of delivery.
New Zealand also has made marked progress in its work of saving the lives and promoting the health of its mothers and babies, having at present the lowest infant death rate in the world. This has been brought about largely through the efforts of the “Society for the Health of Mothers and Children,” an organization employing visiting nurses, called Plunkett Nurses, in honor of the family by that name which has greatly aided the work.
The outstanding features of this work are educational and preventive; the mothers being instructed from early in pregnancy about the care of themselves and the preparation for, and subsequent care of their babies. Prenatal clinics are maintained and the facilities for hospital care are being steadily increased and improved.
One is impressed by the spirit animating this organization, as expressed in a statement of its “functions,” one of which is as follows: “To uphold the sacredness of the body and the duty of health, to inculcate a lofty view of the responsibilities of maternity and the duty of every mother to fit herself for the perfect fulfillment of the natural calls of motherhood, both before and after childbirth, and especially to advocate and promote the breast feeding of infants.” Work based upon such idealism could not but be effective.
The New Zealand undertaking is regarded as patriotic, rather than philanthropic, and mothers who are visited and cared for are accordingly encouraged to pay for this service, if financially able to do so. The Government supervises and warmly supports the work of this Society and also aids by enforcing the most perfect system of birth registration in the world, without which the results of the work could not be accurately gauged.
England and New Zealand, as countries, have pointed the way toward accomplishing a nation-wide reduction of maternal and infant mortality and morbidity by making provision for widely organized prenatal care. They recognize the problem as one of public concern. They get at the heart of it: ignorance on one hand and poor or inadequate care on the other. They apply a practical solution, comprising a system of preventive, instructive prenatal care, together with improved and increased facilities for medical and nursing care at the time of delivery and afterward.
This country has been strangely laggard in making widespread, organized effort along these lines, to safeguard its mothers and babies, through prenatal care. But sporadic, volunteer effort has been made in certain cities, and has been crowned with brilliant success.
The first of these attempts in this country was made in Boston, in 1909, with a maternity nurse working under the auspices of the Women’s Municipal League. The work, which was established by Mrs. William Lowell Putnam, was designed to show what could be accomplished by intensive work in a small group of city mothers, and suggest the feasibility of its extension to larger numbers.
“The routine, which has been evolved through a five-year experiment by the Prenatal Committee of the Women’s Municipal League,” says Mrs. Putnam, “has reduced the infant deaths, among those cared for by a third to one-half, as compared with cases not receiving this care. Still-births have been cut in half. Premature births have been reduced to seven-tenths of one per cent. These results were obtained by supervision during pregnancy only, and at a cost of less than $3.00 per patient; an expense which the patients were always encouraged to meet if possible.
“The success of this venture proved to be so satisfactory that the Boston workers have gone still further toward supplying the needs of mothers and babies by adding to the prenatal care, care at the time of birth and afterwards until the mother is again on her feet. Through the courtesy of one of the largest Boston hospitals, a clinic is held weekly in its Out-Patient Department. The hospital is in no way responsible for the clinic, simply lending the room in which the clinics are held. The medical care at the clinic and in the patients’ homes is given by obstetricians from the staff of the Boston Lying-in Hospital. Medical examinations are made during pregnancy at the clinic, and a nurse visits and instructs the patient during the period of expectancy, always under the direction of a physician. The delivery is performed in the home by a physician connected with the clinic, at which the nurse also is in attendance. She visits the mother and baby twice daily for three days subsequent to the delivery, gradually making her visits less frequent thereafter. The doctor pays from two to four postnatal visits, as may be needed. For this prenatal, natal and postnatal, medical and nursing care, $40.00 is the entire amount charged, and the work is self-supporting with the nurse’s time filled. Prenatal care, alone, is given if desired by a physician and with visits at the clinic included; the charge for this service is $10.00.”